SURGICAL INSTRUMENTS More special nstruments

         The other special instruments in use are:

         •       Thompson lithotrite (Fig. 8.117)

         •       Turner Warwick calculus foreceps (Fig. 8.118)

         •       Rendal renal calculus forceps (Figs 8.119A to C)

         •       Millins boomrang needle (Fig. 8.120)

         •       Dupuytren’s aneurysm needle (Fig. 8.121)

         •       Joll aneurysm needle (Fig. 8.122)

         •       Syme aneurysm needle (Fig. 8.123)

         •       Satinsky clamp (Fig. 8.124)

         •       DeBakey aortic clamp (Fig. 8.125)

         •       Mini bulldog clamp (Fig. 8.126)

         •       Varicose stripper (Fig. 8.127)

         •       Dissectors (Mac Donald/Durham/Watson-Cheyne) (Fig. 8.128).

         Thompson lithotrie is used for crushing stones inside the urinary bladder the stone pieces are then sucked out under negative pressure this avoids opening the bladder.

         Turner-Warwick calculus forceps and Rendal renal calculus forceps are used to hold stones within the upper urinary tracts after exposing the kidney and ureter by surgery.

         Millins boombrang needle is an instrument used to stitch the capsule of the prostate after a retropubic prostectomy.

         Dupuytren’s aneurysm needle, Joll’s aneurysm needle, Syme’s aneurysm needle are blunt needles with handles for passing behind vascular pedicles after they have been cleanly dissected the eye with the thread helps to deliver it behind the pedicle which can thus be ligated

         Satinsky’s vena cava clamp is for holding the side of a vein opening it or repairing it.

         DeBakey’s aortic clamp is for holding the aorta or a part of it is closed during vascular operations.

         Mini bulldog clamp serves a similar purpose for smaller arteries.

         Varicose stripper used for stripping varicose veins. Dissectors are used to separate structures along tissue planes.

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SURGICAL INSTRUMENT Special 17 Biopsy

Special Instruments

To obtain tissue for histopathologic examination is an important part of a surgeon’s functions. Scrappings from cavities are obtained by Volkmann Scoop and Sims uterine curet. Menghini needle and Silverman needle obtain access through unbroken skin and Walton rectal biopsy forceps and Chevalier Jackson biopsy forceps are for obtaining biopsy material under vision through proctoscope or a sigmoidoscope.

         Biopsy instruments are used for obtaining material for histologic examination and those in use are:

•       Volkmann’s scoop (Fig. 8.112)

•       Sim’s uterine curet (Fig. 8.113)

•       Menghini needle (Fig. 8.114)

•       Silverman needle (Fig. 8.115)

•       Chevalier-Jackson biopsy forceps (Fig. 8.116)

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SURGICAL INSTRUMENTS 16 Probes & Dilators

Probes and Dilators

Probes are used to gain entry to small (openings) to get information about their depth, direction and size; they are usually blunt ended.

Dilators are used to investigate the patency and dilate hollow tubular passages.

         Infection trauma and surgical accidents can result in healing by second intention in hollow organs this result in strictures.

         In the past these strictures have been treated by dilatation.

         The dilators have been made of metal or gum elastic. The agreed gauge has been utilized to ensure uniform size in all the sets.

         This also helps the surgeon to choose the correct sized dilator. As dilatations are done gradually over a period of the time, the surgeon records the degree of dilatation achieved so as to start at the next level on the subsequent attendance.

         Corticosteroids can also be used to minimum edema and fibrosis.

         The dilators in use are:

         •       Lister (Fig. 8.106A)

         •       Clutton (Fig. 8.106B)

         •       Tuner-Warwick (Fig. 8.107)

         •       Canny Ryall bougie (Fig. 8.108)

         •       Jackson esophageal bougie (Fig. 8.109)

         •       Neoplex (Fig. 8.110)

         •       Bake’s bile duct (Fig. 8.111).

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SURGICAL INSTRUMENTS 15 Self Retaining retractors

Self-retaining retractors, i.e. Travers, Norfolk, Norwich, Balfours, Alms and Jolls have atleast two blades joined by a hinge joint or bar. It is thus possible to create lateral pressure against both margins of the wound. This helps to retain the retractor in position throughout the duration of the operation.

         Thus freeing the hands of the assistant for assisting the surgeon in other ways.

         Examples are:

         •       Travers (Fig. 8.98)

         •       Norfolk (Fig. 8.99)

         •       Balfour abdominal (Fig. 8.100)

         •       Joll thyroid (Fig. 8.101).

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SURGICAL INSTRUMENTS 14 Hand held retractors

Wound Retractors

Good exposure is one of the requisites of successful surgery. Instruments designed specifically to improve exposure are called wound retractors. They can be hand-held or self-retaining.

         The handle of the retractor is held by the assistant the retracting end is usually at a right angle to this. It smooth rounded with no sharp corner or edges to avoid injury to the tissues. The use of the retractor can be estimated from the depth to which this retracting end can go.

         The varieties in use are:

         •       Langenbeck (Fig. 8.90)

         •       Ollier (Fig. 8.91)

         •       Morris (Fig. 8.92)

         •       Kelly (Fig. 8.93)

         •       Deaver (Fig. 8.94)

         •       Lloyd Davies (Fig. 8.95)

         •       Czerny (Fig. 8.96)

         •       Allison lung (Fig. 8.97).

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SURGIAL INSTRUMENTS 13 Tubes Nasogastric endotracheal tracheostomy

Tubes

Without endotracheal tubes modern anesthesia would be unthinkable. The traditional tubes of the Magill pattern are made of red mineralized rubber. Except for the smallest they all have an inflatable cuff near the distal tip to protect the lower respiratory tract form soiling as well as providing an air-tight seal. Each number refers to the internal diameter of the tube in millimeters.

         All tubes in the past have been made of rubber and have been recycled in practice by autoclaving. All these instruments and nasogastric tubes are now made of nonreactive plastic material and come presterilized in packs. These tubes are all disposable and thus do not require recycling.

         The tubes in use are:

         •       Endotracheal (Fig. 8.79)

         •       Uncuffed oral endotracheal tube (Fig. 8.80)

         •       Negus tracheostomy (Fig. 8.81)

         •       Chevalier Jackson (Fig. 8.82).

Nasogastric

Tubes may have to be passed into the stomach, or even beyond, for decompression, sampling or delivery of drugs or food.

         Ryle’s tube is most commonly used for decompression of the stomach following abdominal surgery or for intestinal obstruction.

         The other tubes used are:

         •       Nasogastric (Figs 8.83A to C)

         •       Sengstaken (Fig. 8.84).

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SURGICAL INSTRUMENTS 12 Catheters & Drains

Catheters & Drains

The Foley catheter is a plastic two-lumen tube with an inflatable balloon. The balloon is inflated via a small channel.

         Suprapubic cystostomy is an alternative way of draining the urinary bladder. The Malecot catheter is well suited for this purpose. It is a rubber or latex tube with two wings at the tip. The de Pezzer catheter is based on a similar principle except that instead of wings, it has a bulbous end which can be straightened and recoils back when the wire introducer is removed.

         The catheters used are:

         •       Foley (Fig. 8.85)

         •       Gibbons (Fig. 8.86)

         •       Malecot (Fig. 8.87)

         •       DePezzer (Fig. 8.87)

         •       Tiemann (Fig. 8.87)

         •       Secured tube drains (Fig. 8.88)

         •       Corrugated (Fig. 8.89).

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